Rwanda : The Digital Health Pioneer, Part 2
RWANDA: COVID-19 RESPONSE
In some places in the world right now, getting tested for COVID-19 remains difficult or nearly impossible. In Rwanda, you might just get tested randomly as you're going down the street.
"So whenever someone is driving a vehicle, bicycle, motorcycle or even walking, everyone is asked if you wish to get tested," says Sabin Nsanzimana, director general of the Rwanda Biomedical Center, which is the arm of the ministry of health that's in charge of tackling COVID-19. Health officials in personal protective equipment administer the test. Nsanzimana says the testing is voluntary, although some others say refusal is frowned upon.
The sample collection — from a swab up the nose — and filling out the contact information paperwork takes about five minutes.
"All these samples are sent that day to the lab," Nsanzimana says. "We have a big lab here in Kigali. We have also six other labs in the other provinces."
Despite being classified by the World Bank as a low-income country, and despite its limited resources, Rwanda has vowed to identify every coronavirus case. Anyone who tests positive is immediately quarantined at a dedicated COVID-19 clinic. Any contacts of that case who are deemed at high risk are also quarantined, either at a clinic or at home, until they can be tested.
Nsanzimana says health workers call or visit every potential contact of someone who tests positive.
"We really believe that doing so is important to make sure we detect and trace where the virus could be," he says.
TRACK AND TRACE
Comprehensive contact tracing is a task that has overwhelmed countries with far more resources than Rwanda. Rwanda's per capita income is roughly $2,000 per year. Yet all testing and treatment for the virus is provided for free.
It costs the government between $50 and $100 to run a single coronavirus test, Nsanzimana says. In order to test thousands a day, Rwanda has started using a process called "pool testing." Material from 20-25 nasal swabs are all put into one vial and run through the machine.
This allows them to test far more samples at once. If they get a positive result, then all the swabs that went into that initial vial are tested individually to pinpoint the person who's infected.
Nsanzimana says Rwanda's experience dealing with other infectious disease outbreaks is helping it now during the pandemic.
The country is using systems and equipment it already had in place to address HIV.
"The main machines we are using for COVID testing are the HIV machines that were (already) there," he says. "We are using the same structure, same people, same infrastructure and laboratory diagnostics, but applying it to COVID testing."
Since recording its first case in mid-March, the country of 12 million has recorded just over 1,500 cases. Ohio has a similar size population and has recently been reporting roughly 1,200 cases a day.
BIG DATA & ANALYSIS
"Rwanda did a few things that are quite smart," says Sema Sgaier, the head of the Surgo Foundation, which has just launched a new data tool to analyze trends around COVID-19 across Africa. "One is they responded really early. They put some of the most stringent lockdowns in place compared to every other African country.
In fact, we've been monitoring physical distancing data across the continent and Rwanda fares, I think, second; they've physical distanced the second most across Africa" — a conclusion based on mobile phone movement data. South Africa is No. 1.
Rwanda mobilized community health care workers and police and college students to work as contact tracers. It set up national and regional command posts to track cases. It's even using human-size robots in the COVID-19 clinics to take patients' temperatures and deliver supplies.
Tolbert Nyenswah, who ran the Liberian ministry of health's response to Ebola in 2014, gives Rwanda high marks for how it has been handling COVID-19, even if at times it's heavy-handed.
"Rwanda, from all indications, is a success story for Africa," Nyenswah says. The strong leadership from President Paul Kagame, which Nyenswah says can even be authoritarian, has been effective during this crisis. Kagame demands accountability from his health ministry.
Whether the people trust or fear the government, Rwandans listen to their government and have been following the orders regarding masks, washing hands and staying home.
Nyenswah worries that the worst is yet to come in Africa with this pandemic.
"No country is out of the woods yet," he says. However, he adds that Rwanda is an example to other low-income countries that even with limited resources, this virus can be contained. "So what needs to be done is to follow the (prevention and containment) measures. Political leadership is very, very crucial. Rwanda should continue what it is doing now. And other countries should emulate Rwanda.
RWANDA: THE DIGITAL HEALTH PIONEER PART 1
Introduction to Rwanda
Rwanda has made remarkable socioeconomic progress in the past decade with real GDP growth averaging 8.2% annually. This has translated into improvements in the health situation. Major health reforms took place, including the health insurance improvement, which aims to guarantee access for all to health care; and experience from Rwanda has shown that it is possible to achieve universal health coverage in a country with 90% of its population in the informal sector.
Life expectancy has doubled during the 20 years following the devastating 1994 genocide against the Tutsi, as a result of increase in the number of health facilities, improvement in immunization coverage, good access to safe drinking water, and improved housing. All targets related to the three health-MDGs were met, with a notable success in reduction of child mortality and considerable improvements in maternal health.
"Rwanda’s eHealth Strategic Plan for 2016–2020 is the key driver to economic growth and to improving the lives of people. Digital health improves service delivery and clinical outcomes, and we know that cannot happen if we don’t look at the data."
Dr. Patrick Ndimubanzi, Honorable Minister of State, Public Health and Primary Health Care, Rwanda
Digital Health Innovation in Rwanda ...